Provider Demographics
NPI:1972744068
Name:PICKEL, STEVEN T (PTA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:T
Last Name:PICKEL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5837
Mailing Address - Country:US
Mailing Address - Phone:732-493-3100
Mailing Address - Fax:732-493-4285
Practice Address - Street 1:65 N SUSSEX ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-3949
Practice Address - Country:US
Practice Address - Phone:973-361-5200
Practice Address - Fax:973-361-8312
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00194100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071419671Medicare PIN